new cases in France, symptoms

[Mise à jour le vendredi 20 novembre à 10h44] At the end of April 2020, doctors alerted the authorities to cases of pediatric multisystem inflammatory syndrome (PIMS) observed in children with some symptoms near Kawasaki disease and for the most part with a Covid-19 infection recent. In Italy, the United Kingdom, Belgium, but also in France, pediatric associations and health authorities have established active monitoring of these atypical clinical pictures. In its November 19 epidemiological update, Public Health France indicates that “from new cases of PIMS have been reported since this fall, bringing to 254 the number of cases observed between 1 March and 15 November 2020 “. These cases remain rare ? What are the symptoms? The following and care? Explanations.

Kawasaki disease or “Lymphocutaneous-mucosal syndrome“was described by Tomisaku Kawasaki in 1967. It is a vascularitis that is, a disease characterized by inflammation of blood vessels which, in the absence of treatment, can complicate with coronary aneurysms which can be fatal. Although this disease has been reported around the world, it is a lot more common in Asian populations, in particular at Japan. In the vast majority of cases, it strikes infants and young children before puberty. This disease is rare in adolescents and adults.

The alert in France was given in April by the Necker hospital which reported cases of 25 children admitted to intensive care in the Paris region with inflammatory syndrome. “This inflammatory syndrome involves heart, lungs o the digestive system, Dr. Damien Bonnet, coordinator of the M3C Necker network in Paris, explained to the daily Midi Libre. The clinical condition of some patients reminds Kawasaki disease.” Some children had recently had a Covid-19 infection. In order to better identify these atypical clinical pictures, hospital pediatricians have been invited, from 30 April, to report any new case possibly related to Covid-19 to Public Health France, as well as retrospectively from 1 March 2020.. New cases of PIMS have been reported since this fall, bringing to 254 the number of cases observed between March 1 and November 15, 2020, indicates the latest French public health bulletin of November 19:

→ 128 cases of “pediatric multisystem inflammatory syndromes” (50%) affected girls.

→ The mean age of the cases was 7 years (25% of cases were ≤ 3 years old and 75% ≤ 11 years old).

→ A stay in intensive care was needed for 118 children (46%) and in intensive care unit for 44 children (17%). The other children were admitted to the pediatric ward.

→ Only a 9-year-old boy is deceased, in an image of systemic inflammation with myocarditis.

→ 62% of cases had a positive PCR and / or serological test for Sars-CoV-2 virus responsible for Covid-19 disease.

→ Almost half of the cases (122) have been reported in the region Ile-de-Franceand between 10 and 27 cases in Auvergne-Rhône-Alpes, Grand Est, Normandy, New Aquitaine and Provence-Alpes-Côte d’Azur.

weekly distribution of hospitalizations for PIMS, according to the link with COVID-19, and COVID-19 hospitalizations for all ages, in France, from 2 March to 15 November 2020 (data as of 17 November 2020)

What is the connection with Covid-19?

The alarm came first UK where the National Health Service (NHS) reported cases of dozens of children hospitalized in serious condition with fever, inflammation of the arteries (associated with “pediatric multisystem inflammatory syndromes” (PIMS) similar to Kawasaki disease) and for more positive for Covid-19. According to a study conducted at the«Robert-Debré hospital (Paris) the incidence of Kawasaki disease-like cases has increased by 500% in April 2020 in the plant, compared to the last 15 years.

““the data collected confirm the existence of a rare multisystem inflammatory syndrome in children with frequent cardiac involvement, linked to the Covid-19 epidemic“

For Pr Albert Faye, head of the pediatrics department of the Robert-Debré hospital interviewed by Francetvinfo, the link between Covid-19 and Kawasaki disease in children “appears quite clearly“ since at that time, SARS-Cov-2 was “The only” circulating respiratory virus. “TO average time to start cases of PIMS 4 to 5 weeks after SARS-CoV-2 infection it had been observed during the first wave, reports Santé Publique France. After a peak observed in week 18 (week of hospitalization), the number of reported cases decreased significantly during the summer, before a moderate increase in late September At week 39: 46 confirmed cases were reported between 21 September and 15 November.

According to data transmitted by Public Health France on November 19, 2020, on the 254 cases of “pediatric multisystemic inflammatory syndromes” (PIMS):

• 62% had a positive PCR and / or serological test for Covid-19 virus.
• Binding to the virus was “probable” in 7% of patients and considered “possible” in 8%. For 23%, the connection could not be established.
• Among the 196 patients for whom a link with Covid-19 was possible, probable or confirmed, PIMS was associated with myocarditis in 72% of cases. Among the 58 unrelated patients, myocarditis was found in only 5 of them.

In total, Santé Publique France concludes, “The data collected confirm the existence of a rare multi-system inflammatory syndrome in children with frequent cardiac involvement, linked to the Covid-19 epidemic, also observed in other countries. In France, the incidence of PIMS linked to Covid-19 is been estimated at 13.5 cases per million population in the population under 18 ” (i.e. 14,511,544 inhabitants, INSEE 2019 data).

What are the symptoms?

Children with Kawasaki disease are in poor general condition. Symptoms suggestive of Kawasaki disease:

• a prolonged unexplained fever, above 38 ° C, which persists for at least 5 days and does not respond to antipyretics or antibiotics,
• rash;
• conjunctivitis that appears with fever;
• oropharyngeal damage (erythema of the lips, dryness, cracks and sometimes bleeding). The tongue is raspberry;
• cervical lymphadenopathy (swollen glands);
• damage to the feet and hands: erythema of the palms or soles of the feet as well as edema, peeling of the skin, i.e. loss of the superficial layer of the epidermis, mainly affecting the area towards the genitals, soles of the feet or palms of the hands.

In coronavirus positive children : It’s about a module “more marked” of Kawasaki disease, with “a digestive attack, abdominal pain“, describes Professor Albert Faye. Inflammation is “a little more important than in classical disease”, with a damage to the heart, inflammation of the heart muscle and inflammation in the pericardium, inflammation “more frequent than in Kawasaki disease” classic.

The severity of this disease is defined by the heart risks that it can generate, in the absence of treatment. “Cardiac complications occur in 25 to 30% of untreated patients, reports La Revue du Praticien. The most important complication is coronary aneurysms, which usually occur between 10 and 30 days after the onset of the disease. ” Among the 196 patients for whom a link to Covid-19 was possible, probable or confirmed, PIMS was associated with myocarditis in 141 cases (72%), Santé Publique France indicated on November 19. Among the 58 unrelated patients, myocarditis was found in only 5 of them. A stay in the ICU was required for 118 children (46%) and in the ICU for 44 children (17%). Only one child, 9 years old, died, in a picture of systemic inflammation with myocarditis

The diagnosis of Kawasaki disease is hard to ask at first, because many childhood diseases have similar symptoms. It is before the combination of the aforementioned signs, classically five of the six signs mentioned above, that the diagnosis is confirmed. Sometimes a blood test is done showing inflammation at its level, but if Kawasaki disease is confirmed, a Echocardiography it should be practiced in search of a coronary aneurysm namely a malformation of an artery of the heart which is the severity of this childhood disease. Thrombosis, blood clots that block a blood vessel, can also complicate this disease.

“Quickly, we can improve things if necessary by combining corticosteroids.”

Kawasaki disease requires hospitalization. Pathology is treated with the help of a combination of drugs. Aspirin is used to prevent thrombosis, associated with a cycle of immunoglobulins that have passed through the veins. “There may be a little more resistance to immunoglobulins, observes Professor Faye. But we can quickly improve things if necessary by combining corticosteroids. ” Additionally, cardiac ultrasound should be repeated to monitor for the occurrence of a possible aneurysm. “Kawasaki disease has become exceptionally severe since it was treated early and effectively with immunoglobulins.” explains Dr. Fanny Bajolle of the Center of Reference “Complex congenital heart malformations-M3C” at the Necker Enfants Malades hospital. Of the relapses are possible but rare.

Sources:

COVID-19: epidemiological update of November 19, 2020, Public Health France, November 19, 2020.

Kawasaki disease in four tables. Dr Fanny Bajolle. Center of reference “Complexes of congenital cardiac malformations-M3C” of the Necker Enfants Malades hospital. 2011.

Kawasaki disease; R. Cimaz *, J.‑C. League; Hospice Civiles de Lyon, Claude-Bernard University, Lyon-1; 2007.